Healthcare Provider Details

I. General information

NPI: 1942467154
Provider Name (Legal Business Name): STRATEGIC WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 CHAMBER CENTER DR
LAKESIDE PARK KY
41017-1669
US

IV. Provider business mailing address

2106 CHAMBER CENTER DR
LAKESIDE PARK KY
41017-1669
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-4673
  • Fax: 859-426-5175
Mailing address:
  • Phone: 859-426-4673
  • Fax: 859-426-5175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0772
License Number StateKY

VIII. Authorized Official

Name: DR. JASON SCOTT BLUEMLEIN
Title or Position: CEO
Credential: ED.D.
Phone: 513-379-7214